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“COVID-19 & Lung Function in Young People” It is a well known fact that in general, infants and children have a higher susceptibility to viral respiratory tract infections in comparison to older individuals. However, what is interesting about this is that younger people who are infected with COVID-19 have a tendency to manage more successfully in comparison to adults. For example, it has been noted that when children and teenagers do contract the virus, they tend to experience symptoms that are more mild. One systematic review that looked into this phenomenon was published in Pediatric Pulmonology initially in June 3rd of 2020. It covered 1,124 cases and again noted that younger people who have contracted COVID-19 tend to fare far better than their adult counterparts. Out of this large number of patients, only a very small proportion of the children included became seriously or critically ill. Another study encapsulating this theme is one is led by Dr. Ida Mogensen, who is a postdoctoral fellow at the Karolinska Institute out of Stockholm, Sweden. Dr. Mogensen and her team of researchers began by collecting data from exactly 661 individuals with an average age of 22 years. Out of this group, 27% carried antibodies that connote a past COVID-19 infection. The researchers then analyzed lung function measurements, eosinophils, and inflammation markers within the participants. Eosinophils are a variety of white blood cells related to a degeneration in lung function. Dr. Mogensen and her team stated, “We found no difference in lung function change with respect to blood eosinophils, fractional exhaled nitric oxide [a measure of airway inflammation], allergic sensitization, or ICS use.” It was noted that participants with asthma didn’t display a noticeable decline in lung function, but they did have somewhat lower measurements of forced expiratory air volume, which is another measure used for lung function. Another doctor presented a study concerning pulmonary function in young people after a COVID-19 infection between August 2020 and March 2021. This doctor was Dr. Anne Schlegtendal. She is a specialist in pediatric and adolescent medicine, as well as pediatric pulmonology at the University Children’s Hospital, part of Ruhr University, in Bochum, Germany. Within this study, Dr. Schlegtendal and her team collected data from 73 participants who were 5 to 18 years of age. The data was collected at 2 weeks, as well as 6 months after a positive COVID-19 diagnosis. The collected data was compared and contrasted against the control group, which consisted of 45 people who had not tested positive for COVID-19, although it was unsure whether they had suffered any other types of infection. This study led Dr. Schlegtendal to a similar conclusion that COVID-19 doesn’t tend to diminish pulmonary function among children and adolescents. Another doctor seems to have a theory or explanation as to why children and teenagers seem to have much lower susceptibility towards the COVID-19 virus when compared to adults. Dr. Demet Toprak, who is an assistant professor of pediatrics at the University of Washington School of Medicine, as well as the medical director of the Pulmonary Diagnostic Lab at Seattle Children’s Hospital, spoke to online news publication, Medical News Today. In an interview she shared,“with the lockdown that happened very early during the pandemic, obviously, families protected their kids much better than they protected probably themselves or the adult population.” Before anyone is able to talk about if children and teenagers are less susceptible to more severe COVID-19 infections, the limitations of all the previously mentioned studies must first be taken into account. One major limitation is the small sample sizes and short time frames of both Dr. Mogensen as well as Dr. Schlegtendal’s study. Dr. Toprak also believed that the data collected could have been “utilized a little bit better.” Therefore, until larger studies are completed, there are still a wide range of questions aimed towards this topic that need to be explored. Many medical professionals, however, are urging parents and guardians not to take this study information to mean that their children are safe or necessarily protected from COVID-19. Most specifically, since there are COVID-19 cases exploding in numbers, especially in the United States, due to the spread of the Delta variant. Because of this, cases in children are multiplying. As always, health professionals recommend practicing safety and following local mask mandates.
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Inability Of The Brain To Adapt To Stress May Be A Cause Of Depression

Major depressive disorder or MDD is one of the most common health conditions  in the United States, and the second most prevalent illness in the U.S. today. It is also  known as clinical depression. The National Alliance of Mental Illness, (NAMI) has stated  that more than 19 million U.S. adults, nearly 8% of the population, has had at least one  significant depressive episode in 2017. Statistics have been rising with the prevalence  of COVID-19.   A recent report funded by the Centers for Disease Control and Prevention (CDC)  has reinforced this idea, suggesting that the stress of the COVID-19 pandemic may be  connected with an increase in self-reported depression and anxiety symptoms. This is  particularly true with adults under 30 years of age.   The summary of the research paper highlights that large disease outbreaks have  often been associated with an increase in mental health issues. The report also shares  that from August 2020 to February 2021, the percentage of adults who recently  reported symptoms of an anxiety or depressive disorder increased from 36.4% to  41.5%. Additionally, the report states that the percentage of those who feel they have  unmet mental health care needs has increased from 9.2% to 11.7%. Again, these  increases were considered the largest among adults less than 30, as well as those with  less than a high school education.   Stress over a prolonged period of time, such as during a global health  pandemic, is what many experts associate with the development of depression. One  well known symptom of depression is anhedonia, which is the lack of ability to  anticipate or feel pleasure. However, researchers do not have a full comprehension of  how chronic stress can lead to depression or the accompanying symptoms of  anhedonia.   Past evidence has suggested that the medial prefrontal cortex (mPFC), may be  involved in moderating the effects of chronic stress. The mPFC is an important region  of the brain that is involved in processing rewards and managing the stress response.  Acute and chronic stress can evoke changes within the mPFC. An example of this is   done in studies involving rodents.   One study was published in 2009 of August by PNAS, or the Proceedings of the  National Academy of Sciences of the United States of America. Within in study, it was  discovered that rodents excrete glutamate through neurons in the mPFC during acute  stress. Glutamate is an excitatory neurotransmitter, and it is responsible for sending  signals between nerve cells. Under normal conditions, it plays a large role in learning  and memory.   Rodents that are exposed to chronic stress have been shown to carry lower  levels of glutamate release within the mPFC when they face a new stressful event.  According to scientists, this reduction in the mPFC glutamate response due to chronic  stress could be an adaptation that developed to protect the rodents. Other studies  have already revealed that mPFC glutamate activity is modified within individuals who  have depression.   Another study, which was led by researchers located at Emory University in the  United States, shows that individuals who suffer from depression are unable to  produce the aforementioned adaptive decrease in mPFC glutamate levels that are  produced in response to a recent increase in stress. This is unlike individuals who do  not have depression. Also, the scale to which a depressed individual lacks such an  adaptive response can predict their anhedonia levels within everyday life. The study  was published in 2021 in medical journal, Nature Communications.  The researchers decided to further investigate the role of the mPFC in  depressed individuals. They found 65 people without depression and 23 people with  depression who were not currently taking medication. The researchers used the  Perceived Stress Scale, or PSS, to measure each participant’s perceived stress levels  over the past month.   On the day of testing, participants completed a task meant to invoke acute  stress. The researchers used magnetic resonance spectroscopy, known as MRS. It is a  noninvasive imaging technique that measures changes in glutamate levels in the mPFC  before and after the acute stress test.   The researchers found that those individuals without depression and with lower  levels of recently perceived stress had an increase in mPFC glutamate levels afterward.  The individuals without depression, but who also had higher perceived stress showed  no change or a decrease in mPFC levels. As far as the mPFC glutamate levels of  people with depression during the acute stress test, the changes had no visible  correlation with their PSS score. The study authors believe that the absence of  adaptation within an individual’s mPFC glutamate levels could play a major role within  the growth of stress-related mental health conditions, like depression.   Further on in the study, researchers continued to survey the participants who  had depression. They did this every other day after the stress test for a total of four  weeks. However, these surveys looked at the participant’s optimism or pessimism as  far as their daily activities are concerned, along with the actual outcomes of these  activities.   The participants with MDD were found more likely to have inaccurate  pessimistic expectations when compared to those without depression. The researchers  ended up making a model using the mPFC glutamate response data that was collected  from the individuals who didn’t have depression. By using this, they were able to  measure the quantity of the extent to which the mPHC glutamate response in  participants with MDD was different from those without depression.  The researchers named this score the maladaptive glutamate response, or the  MGR. The MGR score in these participants with MDD was positively associated with  inaccurate pessimistic expectations. This means that the extent to which the MDD  afflicted participants did not exhibit an adaptive decrease in mPFC glutamate levels  during acute stress is correlated to an inability to anticipate pleasure or anhedonia.   However, there are many limitations among this study. The authors of the study  themselves note that the variation of PSS scores did not coincide among people with  MDD. The study authors are quoted as saying “This was not entirely unexpected, as  PSS scores are known to be much higher in MDD samples; however, it does limit our  ability to determine whether the maladaptive glutamate response we observed was  driven primarily by the high severity of perceived stress in MDD, the presence of their  current depression, or both.”
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BLACK FUNGUS

“Mucormycosis or Black Fungus” Mucormycosis, known as “Black Fungus,” is a fungal infection that results in the nose becoming blackened or discolored. Other symptoms include blurred or double vision, chest pain, breathing difficulties and coughing up blood. Recently, it has caused over 2,100 deaths among COVID-19 patients in India, and over 11,000 confirmed cases. The disease, which is usually quite rare, has a mortality rate of around 54 per cent, according to the US Centers for Disease Control and Prevention. This rate is contingent on the condition of the patients’ health, as well as the body parts affected. Without immediate treatment using anti fungal medication and surgery to remove ensuing necrotic tissue, mucormycosis can easily be fatal. The infection is closely linked to diabetes, and other conditions that cause the immune system to be compromised. Some experts believe that the overuse of certain immune system suppressing drugs could be behind India’s recent surge. An example of this is the steroid dexamethasone, which is used by intensive care doctors. One myth surrounding the fungal infection is that it is contagious, which it is not. It can not be spread from human to human contact, or human to animal contact. It can spread from fungal spores present in the air or environment, which are practically impossible to avoid. The ensuing infection will then rapidly spread from the nose and sinuses to the face, jaw, eyes and even brain. The fungus blocks blood flow, killing infected tissue. It is then this dead, or necrotic tissue that results in the characteristic black discoloration of people’s skin. One professor, Malcolm Richardson, who is a professor of medical mycology at the University of Manchester in the United Kingdom, believes the name to be “totally inappropriate.” He shares this because the actual fungus is transparent, not black. Generally, our immune system is able to fight off this particular fungi, but when paired with diabetes, COVID-19, and steroid treatment, a person’s immunity can be weakened to the point that these microorganisms can gain some traction. Some experts believe that the unsanitary conditions at some hospitals in India could heighten the risk of developing the infection. An ophthalmologist at Hinduja Hospital in Mumbai named Nishant Kumar is quoted as saying, “There is a lot of contamination in the pipes used for oxygen, the cylinders that are being used, the humidifiers used.” He continues by saying, “If you are immuno-suppressed, and you have been on these pipes and oxygens for a long period of time, then these infections get much more of an opportunity to get in.” Strangely, other doctors and scientists do not agree with Dr. Kumar and consider this to be a myth, as black fungus cannot produce spores in fluid, and there is no evidence backing this. Older studies on the infection that were published in 2014 and 2016 implicated hospital linens from poorly managed laundries as a source of the fungus spreading. Another 2009 review that researches hospital outbreaks list wooden tongue depressors, adhesive bandages, ostomy bags, and ventilation systems. One report from the University of Kentucky in Lexington believes that another route of transmission is the inhalation of spores that travel by dust from nearby buildings that may be under construction, or contaminated air-conditioning filters. Opinions between experts are divided, however. SP Kalantri, who is a senior doctor and researcher at the Mahatma Gandhi Institute of Medical Sciences in Maharashtra has said, “Hospitals were dirty even before April. We need epidemiological studies to assess why these cases are rising now.” It’s important to also note that even before the pandemic, the prevalence of mucomycosis may have been around 70 times higher in India in comparison to the rest of the world. One systematic review that took place in 2021 looked at all COVID-19-related cases of black fungus published in one scientific literature. Dr. Awadhesh Kumar Singh and his co-authors discovered 101 cases, with 82 of them in India and 19 from the rest of the world. Among the aforementioned cases, 31 per cent resulted in a fatality. The authors also reported that around 60 per cent of all the cases were actively infected with COVID-19, while 40 per cent happened post recovery. Several myths surround the fungal infection, two we have already mentioned. Another myth is that face masks can harbor black fungus. There is no evidence pointing to this. The last myth is that onions are to blame for the fungal infection. Again, a misattribution purported through social media. Possibly the most harmful myth is a video circling social media that claims a concoction of mustard oil, potash alum, rock salt, and turmeric can cure mucormycosis. However, as mentioned previously, the only treatments that are proven to work is surgery performed to remove necrotic tissue, along with the antifungal drug called amphotericin B. This has now ended in severe shortages of the drug in India. Currently, there hasn’t been any news coverage on black fungus infection being discovered in America. Some tips to avoid possible exposure is wearing protective gear such as a mask when visiting dusty construction sites, along with long sleeved shirts and long pants. The Outlook India website is also urging people to wear gloves while handling garden soil, moss, or manure. Practicing good personal hygiene habits is always necessary, and calling a doctor in case any symptoms occur.
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Heart Failure Patients More Likely to Suffer From Depression and Anxiety

Heart failure is a chronic and progressive condition where the heart muscle becomes unable to pump the adequate amount of blood needed to supply the body with enough blood and oxygen to thrive. Heart failure affects about 65 million individuals worldwide and is considered more deadly than some forms of cancer. The number of co-existing conditions found in heart failure patients is currently on the rise, and these conditions are associated with a poorer quality of life. <br>One 2018 study examined how frequently the psychological conditions, depression and/or anxiety, occur in patients with heart failure when compared to various types of cancer. The study utilized information taken from the German Disease Analyzer database, which is a representative nationwide database that includes around 3% of outpatient patients in Germany. <br>The analysis, which occurred retroactively, looked at adult patients that had been originally diagnosed with heart failure, breast cancer, prostrate cancer or digestive organ cancer. This took place among 1,274 general medical practices or clinics, between the years of 2000 and 2018. This came to a total of 96,772 heart failure patients, 21,261 patients with breast cancer, 16,478 patients with prostate cancer, and 29,479 patients that had cancer of the digestive organs. <br>The study, published in Harv Rev Psychiatry Journal, attempted to identify possible associations between depression, anxiety and heart failure. In order to do this, researchers performed a targeted literature review. They examined the processes that effectuate relationships between these conditions and their medical outcomes, as well as identifying methods for accurately diagnosing depression and anxiety disorders prevalent in heart failure. Lastly, they reviewed current evidence for treatments of these conditions among the population subjected to them.<br><br> Researchers found that both depression and anxiety disorders are incidentally linked with the development and later progression of heart failure. This includes increased mortality rates. Nevertheless, it can be sometimes difficult to accurately diagnose depression or anxiety disorders among patients with heart failure, due to the shared or similar symptoms among these conditions. The German researchers found evidence that cognitive behavioral therapy has displayed an ability to improve mental health outcomes when it comes to patients with heart failure, especially alongside the administration of selective serotonin reuptake inhibitors, or SSRIs. <br>For example, within five years after a patient’s initial diagnosis with heart failure, 23.1% had developed depression or anxiety. This is in comparison to 25.7% of breast cancer patients, 22.1% of digestive organ cancer patients, and 15% of prostate cancer patients. They found that around one in four patients who suffer from heart failure are depression or anxious. <br>These findings also revealed that patients with heart failure were about 20% more likely than cancer patients to develop the aforementioned mental health issues within five years after their initial diagnosis. The only area where this was untrue was when observing the risk of developing depression and/or anxiety among heart failure patients and those with breast cancer. In this area, this risk occurred at a very similar rate. Perhaps not so surprisingly, the incidence of depression and anxiety presenting itself increased continuously over the next five years of follow-up after an individual’s initial diagnosis. <br>The study concluded with the statement that depression and anxiety disorders are commonplace among patients with heart failure. These conditions are also under recognized and often linked to negative outcomes, but the aforementioned researchers believed and still believe that further research is essential. Also, the study highlights the importance of providing psychological support services for patients with heart failure. <br>Especially as these services already exist for cancer patients. Therefore, why shouldn’t equal services be provided to a group with a condition that kills just as many? Or, in some cases, more. <br>For now, let us allow researchers to aspire in their will to be the next to discover the cause behind this phenomenon. Until then, let’s also hope individuals with heart failure are able to find the help they need. Mentally, as well as physically.
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The public has been wearing masks for over a year now. It has become a part of our day to day lives. Now, with more and more individuals being vaccinated, restrictions are being lifted. The question on the minds of many is if it is necessary to wear masks outdoors? Especially when not surrounded by people. The fact stays that the majority of viral transmission doesn’t happen outside. The Journal of Infectious Diseases reported in November of 2020 that the odds of any viral transmission is 18.7 times more likely to happen indoors, rather than out. The review also revealed that less than 10% of COVID-19 infections studied were transmitted indoors. Other professors believe that the actual number of instances of outdoor transmission was even lower than 10%. The US Centers for Disease Control and Prevention have written on their website that masks are generally not necessary outside, especially when you’re six feet away from others, or are with those from your household. However, there is nothing on the CDC’s website that specifies about the role vaccinated individuals play. Director of the CDC, Dr. Rochelle Walensky spoke on the topic to NBC’s Today Show. “We’ll be looking at the outdoor masking question, but also in the context of the fact that we still have people who are dying of COVID-19.” It appears that the answer to the question of whether one should or should not wear a mask outdoors is not always explained in definite terms. For example, it is based on various factors such as vaccination status, percentage of positive cases and the transmission rate within that particular community. These should always be considered before being outdoors, unmasked. Of course being vaccinated is first on the list for avoiding infection. Lindsey Marr, who is an expert on the airborne transmission of viruses at Virginia Tech, spoke to CNN about the topic. “If you’re vaccinated and not in a vulnerable category, it’s probably fine not to wear a mask outdoors.” Marr also tells CNN that masks should be worn in situations when people are close together, like in a bar or small crowd. “If you’re unvaccinated and constantly passing by people close enough that you can reach out and touch them, then you should wear a mask.” Many experts believe that masking will soon transition to being an indoors only expectation. Some states have already made the transition. Other states such as Texas, Alabama, and Florida have lifted their statewide mask mandates, and even more states are now beginning to loosen pandemic guidelines. The CDC still repeats that a mask is not a replacement for social distancing. Everyone should still wear a mask, and stay six feet apart from others. Masks should always cover the nose and mouth, fitting tight against the face without any gaps. Sadly, until this pandemic is over, masks will probably continue to be a full time requirement, both indoors and outdoors in most states and counties. However, as the percentage of vaccinated individuals increase, social isolation will become less and less of a necessity.
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Marisa Takiguchi
Marisa Takiguchi

The Mental and physical health deterioration caused by missed doctor's appointments during the covid-10 pandemic

&nbsp;During a massive portion of 2020, especially during the beginning of&nbsp; the pandemic, many businesses closed down temporarily due to COVID-19&nbsp; restrictions. Those that were able to stay open, the essential businesses and&nbsp; certain doctor’s offices and such, had to attempt to navigate this bizarre new&nbsp; world. For some offices, they begun care at an emergency only basis. People&nbsp; that had appointments were canceled. Even as restrictions somewhat loosened and appointments were able to be rescheduled, many people felt uncomfortable to do so, due to the coronavirus and the valid fears that surround it.&nbsp;&nbsp; &nbsp;A new report titled “Delayed and Forgone Health Care for Non-elderly&nbsp; Adults during the COVID-19 Pandemic,” has been recently published on the&nbsp; Urban Institute’s website on February 16th, 2021. They used data from over&nbsp; 4000 adults aged 18 to 64, collected by their own September 2020&nbsp; Coronavirus Tracking Survey. While reviewing the data compiled by the&nbsp; survey, researchers noticed around one-third, or 36% of non-elderly adults&nbsp; delayed health care or did not get care because they were either concerned&nbsp; about being exposed to the coronavirus, or because their health care&nbsp; provider was offering limited services due to the pandemic.&nbsp;&nbsp; &nbsp;Among those who did delay or completely miss a health care appointment, 32.6% revealed that the gap in care caused one or more of their health conditions to deteriorate, or restrict their ability to be productive&nbsp; at work or other daily chores and activities. Researchers note the findings exemplify “the detrimental ripple effects of delaying or forgoing care on overall health, functioning, and well-being.”&nbsp;&nbsp; &nbsp;The Urban Institute examined the data encompassing delayed or forgone care during the pandemic for nine different types of health care services and analyzed patterns by race/ethnicity, income and the presence of pre-existing physical and mental health conditions. The nine different areas of health care questioned in the survey concern delays in prescription drugs, general doctor and specialist visits, going to a hospital, preventive health screenings or medical tests, treatment or follow-up care, dental care, mental health care or counseling, treatment of counseling for alcohol or drug use, and other types of medical care.&nbsp;&nbsp; &nbsp;They noticed that individuals with one or more chronic health problems&nbsp; are more likely to have delayed or forgone care. The numerical difference&nbsp; being 40.7% versus 26.4%. Those with a mental health condition were&nbsp;particularly susceptible. Dental care was the most common delayed area of&nbsp; health care among respondents at 25.3%, followed by general doctor or specialist visits at 20.6% while preventive health screenings or medical tests stand third in line, at 15.5%.&nbsp;&nbsp; African American adults were more likely than White or Hispanic/Latino adults to report having delayed or forgone care at 39.7%, with White adults at 34.3%, and Hispanic/Latino adults at 35.5%. Also, low income individuals were of higher likelihood to have forgone multiple types of care at 26.6%,&nbsp; when compared to their high income counterparts at 20.3%.&nbsp;&nbsp; &nbsp;Some doctors are already noticing the repercussions of these missed visits. Dr. Jacqueline W. Fincher, president of the American College of&nbsp; Physicians tells Medscape about two patients of hers that missed&nbsp; appointments during 2020. Both patients have long-term health issues.&nbsp; When they each began care again in 2021, their laboratory tests revealed noticeable kidney deterioration. Fincher, who works as a general internal medicine physician in Georgia, shares that one of the patients “was in the hospital for three days and the other one was in for five days.”&nbsp;&nbsp; &nbsp;According to Fincher, her office in particular vows to have been take charge when it comes to reminding patients with chronic diseases who have&nbsp; missed follow-up appointments or have laboratory tests to reschedule. She&nbsp; states they are also proactive as far as calling patients who may have run&nbsp; out of medication. Dr. Fincher states that the majority of delays have been at&nbsp; the fault of the patient postponing appointments. Her office has been open&nbsp; during the entirety of the pandemic, and provides telehealth appointments,&nbsp; as well as in-person visits that follow the CDC’s suggested safety&nbsp; precautions.&nbsp;&nbsp; &nbsp;One article published online on Frontiers in Psychology during September of 2020, similarly talks about the “devastating ripple effects of the COVID-19 crisis.” Written by Michaéla C. Schippers, she believes it to be “expected that hundreds of millions of people will die from hunger and postponed medical treatments.” However, there is no current data backing the numerical validity of her prediction, but there is research that seems to support her claims surrounding the possible negative effects the lockdown may have on an individual’s mental health, along with the dangers&nbsp; surrounding delayed health care.&nbsp;&nbsp; &nbsp;Schippers believes many of the negative psychological effects crafted&nbsp; by the COVID-19 virus can be counteracted “by means of online life crafting&nbsp; therapeutic writing interventions,” and various other coping methods. She&nbsp;explains that life crafting expressive writing can generate positive emotions,&nbsp; be very self motivating, and ascribe new meaning to one’s life. It is the&nbsp; practice of writing about one’s ideal life and goals, including plans to achieve&nbsp; these goals. Schippers cites various sources to support her theory that these&nbsp; sorts of writing exercises may be productive in improving well-being. Some&nbsp; of the other positive coping strategies she mentions is healthy eating and&nbsp; exercise, as well as social support.&nbsp;&nbsp; &nbsp;She ends her article with several suggestions, one of which advocates&nbsp; for the government to provide the public with more information about&nbsp; effective coping methods. Schippers also states that her hope is that “the&nbsp; negative side effects will, to some extent, be counteracted via smart&nbsp; interventions and community care.”&nbsp;&nbsp; &nbsp;As many are aware, chronic problems that are left on their own,&nbsp; whether they be mental or physical, can often result in internal damage.&nbsp; Many of the issues that have come from delayed and foregone appointments&nbsp; due to the COVID-19 pandemic have not been studied yet. As experts&nbsp; uncover and analyze further data surrounding patient outcomes, a better&nbsp; picture of these negative repercussions can be formed. Regardless, this&nbsp; teaches not to ignore or postpone healthcare appointments, whether they&nbsp; are physical or mental, all are important. Medical facilities have many&nbsp; procedures in place currently designed to protect themselves and the&nbsp; general public from further transmitting coronavirus, and if possible in one’s&nbsp; current situation, telehealth care services are highly recommended.
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Inflammatory Bowel Disorder and Newly Found Molecular Master Switch

Inflammatory bowel disorder, or IBD, is an umbrella term that is used to catalog disorders that involve chronic inflammation of the digestive tract. These include ulcerative colitis and Crohn’s disease. Both disorders are characterized by diarrhea, bleeding of the rectum, bloody stools, abdominal pain, cramping, fatigue and unintended weight loss. Both are largely debilitating and can even lead to fatal complications. A main difference between ulcerative colitis and Crohn’s disease is that the first disorder involves inflammation and ulcers along the large intestine’s lining and rectum. While Crohn’s disease also involves inflammation of the digestive tract’s lining, it can also involve deeper layers within the digestive tract. Exact causes of IBD are still unknown. Although theories have been formulated. Medical researchers believe one possible cause behind IBD is the immune system backfiring, and attacking the cells in the digestive tract instead of the intended foreign virus or bacteria. Some risk factors are thought to include family history, cigarette smoking, and non steroidal anti-inflammatory medications like Advil and Motrin IB. Some complications that can occur as a result of ulcerative colitis and Crohn’s disease include colon cancer, blood clots, malnutrition, anal fissures, fistulas, perforated colon, and bowel obstruction. It’s estimated by the Centers for Disease Control and Prevention that 3.1 million people in the United States have IBD, according to surveys done in 2015. Corticosteroids are a treatment often used to cause a reduction in the inflammation that is a result of IBD. The issue with this though is that other areas of the immune system that are essential to repairing damaged tissue are sometimes impeded. This is because immune cells known as macrophages work to cause inflammation but also work in repair processes. Macrophages are a type of white blood cell that encompass and kill microorganisms, eliminate dead cells, and stimulate other immune system cells in action. So while they can get rid of cellular debris and microorganisms, they can also release signaling molecules that begin the inflammatory or repair processes. But this molecular mechanism that allows them to switch from inflammatory mode to repair mode has remained unknown, till now. Sufferers of now have something to possibly look forward to. A 2020 research paper published in “Gut” medical journal believes they have discovered this “master switch” inside the body that can initiate healing within the intestinal tract. Researchers out of Seoul National University College of Medicine looked at humans and mice that developed IBD. They started by looking at macrophages within the intestines of human participants who were currently having a flare-up. The researchers discovered that the IBD sufferers had lower numbers of one specific kind of macrophage in their gut, in comparison to those who don’t have IBD. But when the flare-up was over, the number of these particular macrophages increased. Due to this, it was believed apparent that these macrophages have a role within the reparative process. These cells also had receptors within their cell membrane for a molecule named prostaglandin E2, or PGE2. This is a hormone-like signaling molecule, that is known to be associated with tissue regeneration. During the second part of the study, the researchers looked at the mouse equivalent of the aforementioned macrophages. Again, the mice had ulcerative colitis, which is one kind of IBD. This uncovered that the cells with PGE2 receptors were not very prevalent in the animals with IBD. But when the researchers increased PGE2 levels within the animals’ guts, they released a substance that contributes to tissue regeneration. The substance is abbreviated to CXCL1, with the scientific name being chemokine (C-X-C motif) ligand 1. To test their theory that PGE2 receptors are behind the macrophages’ ability to switch from inflammatory mode to healing mode, the scientists engineered mice whose bodies couldn’t produce the receptor. Their hypothesis in this particular case ended up being true, and these particular mice had a hard time attempting to repair the cells lining their gut. Then the researchers dispensed a drug that stimulated the cells into making CXCL1, thereby reinstating the macrophages’ potential to heal. They were able to deliver this drug to the mice through liposomes that were ingested by the macrophages. Liposomes are spherical small fluid filled sacs that are formed artificially to carry drugs or substances into cell tissues. Since this is all a newly released study, and new information regarding macrophages and their role within inflammatory bowel disorders, much more research will have to be completed before this information can assist current day sufferers. Regardless, this is a positive turn of events for the scientific and medical community. Author: Angelica Trpkovski
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Growing tomatoes in hawaii

Tomatoes can be difficult to grow in Hawaii, but if you follow these steps you can look forward to tomatoes much tastier and vibrant than what you find in supermarkets. You can grow tomatoes all year round in Hawaii thanks to our warm, generally sunny climate. Tomato plants need 6 to 8 hours of direct sunlight a day and do not like wet or humid conditions. Some important tips to keep in mind: Tomatoes are 95% water, 3% carbohydrates, 1% protein, and 1% fat along with vitamins A, B, and C and minerals like calcium, magnesium, potassium, and zinc. They also contain a unique antioxidant called lycopene, which is what gives tomatoes their brilliant red color. Some research has shown lycopene can lower cholesterol levels and blood pressure (Cheng, 2017; Salehi, 2019), so eating tomatoes may benefit you in more ways than one! Research evidence also shows eating cooked tomatoes or tomato products with olive oil or other healthy fats increases the amount of lycopene absorbed (Friedman, 2013). Local favorites like spaghetti or chili would take advantage of this benefit! Avoid eating tomatoes if you have certain medical conditions like:&nbsp; Have you grown tomatoes in your yard?&nbsp; What kind of tomatoes have you grown? Having problems growing tomatoes? Share them here so we can help you troubleshoot and find a solution. What dishes or cuisines that use tomatoes do you enjoy?
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The Dreaded Pelvic Exam

<b>Do I really need one every year?</b> The pelvic exam can be one of the most dreaded procedures that many people experience. I remember my first one very clearly. I guess I was lucky because thankfully, everything went well. But luck doesn’t happen on its own for most of us. There’s usually some sort of reason behind a good result.&nbsp; I believe the main reason why my pelvic examination experience was positive is because I trusted my provider and she explained exactly what to expect in a comfortable and open way. She also gave me a few tips and tricks to help make the whole thing as easy as possible, which I’ll cover later, so keep reading! So let’s start off with the bigger picture.&nbsp; <b>What is a pelvic exam?</b> A pelvic examination is a comprehensive term used to describe a physical examination of the uro-gynecological body parts. Basically, everything between the belly button and groin. It is made up of a few sections: Visual exam, speculum exam, Pap smear, and manual exam.&nbsp; <b>Why are pelvic exams important?</b> As much as medicine has evolved and improved over decades, we still have not figured out an easier way to thoroughly and safely assess this part of the body. No scans or blood tests can substitute for a pelvic exam, unfortunately. I’m sure whoever figures out a substitute will make A LOT of money. <b>When do I get a pelvic exam?</b> For most women, pelvic exams occur during well-woman visits. This visit allows a women’s health provider to cover all of the necessary screenings and treatments of obstetric or gynecological concerns. Unfortunately there is a stigma of well-women visits due to uncomfortable discussion and patients may have a lot of unanswered questions without knowing how to express them.&nbsp; In my family, our Asian culture dictates that young women don’t need a well-woman visit unless they are pregnant or there is something drastically wrong with their reproductive system. So I was discouraged to see a women’s health provider, which was unfortunate but continues to be a reality for many young women. For those who do have the privilege of accessing to a women’s health provider, a well-women visit is a great opportunity to ask questions, gain knowledge, and feel more confident in their body. Some other topics and questions that are commonly discussed during a well-woman visit include planning for pregnancy, vaginal discharge, sexually transmitted illnesses, pain related to intercourse, mood swings with menstrual period, and even history of trauma. A well-woman exam is a perfect and safe time to bring to light personal questions regarding topics such as these. Your provider should be able to address your concerns in a way that is open and nonjudgmental. However, that brings us back to one of the most infamous parts of a well-woman exam. The dreaded pelvic exam. <b>Wherein lies the last question - Do women really need a pelvic exam every year?</b> The most closely followed recommendation comes from the American College of Obstetricians and Gynecologists (ACOG). Their guidelines state: Other society recommendations include United States Preventive Services Task Force (USPSTF), American College of Physicians (ACP), American Academy of Family Physicians (AAFP). They agree that there is insufficient evidence to do screening pelvic exams for asymptomatic and nonpregnant women unless there is evidence for a health or cancer screening concern.&nbsp; Other symptoms that might clue a provider into recommending a pelvic examination include: So it is important to have a discussion with your provider and decide whether a screening pelvic exam is appropriate for you. Everyone is in a different stage of life and health. One of my close friends declined to have a pelvic examination until she was 33 years old because of personal and religious reasons. She had a thorough discussion with her provider and they came to a decision together to hold off until a more appropriate time, which was completely fine for her situation. The consensus is clear - NO you do not necessarily need an annual pelvic exam. But it is crucial to discuss this with your provider! <b>If it is appropriate for you to undergo a pelvic exam, here are some tried and true tips to help prepare for a (relatively) easy experience:</b> <b>Relaxation is key.</b> If your muscles are tense, the examination is going to be more uncomfortable. Being mentally present and relaxing the pelvic muscles will make your experience tenfold more tolerable. Identify the muscles that you use to hold your bladder and relax them one by one until all the tension disappears. Don’t forget to breathe.&nbsp; <b>How to prepare.</b> For the most accurate exam and to avoid any false test results, the best recommendation is to avoid vaginal intercourse, douching, or inserting anything into the vagina within 24 hours before your exam. <b>Don’t worry about what you look like!</b> Having someone who is basically a stranger look at you down there can make anyone feel self-conscious. Your provider has been trained on how to approach this type of appointment and what they see is never based on cosmetic standards. They are looking for strictly anatomical abnormalities and know which steps to take next if anything is identified. <b>Your provider won’t do anything you don’t want to.</b> Ultimately, your health is in your hands. Say for example, you go into a well-woman exam and decide with your provider to start a pelvic examination. If, halfway through the exam, you start feeling very uncomfortable, then the provider will do their best to address those concerns immediately.&nbsp; <b>Confidentiality.</b> This is above all! Nothing that is shared leaves the examination room, unless it is with your consent.&nbsp; So to sum things up, a pelvic exam is a common discomfort in most women’s lives, but there are many reasons for its necessity. And despite its notorious experience, there are ways to prepare beforehand to help improve your experience! Sources: <a href="https://www.aafp.org/afp/2015/0515/p732.html">https://www.aafp.org/afp/2015/0515/p732.html</a> <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/the-utility-of-and-indications-for-routine-pelvic-examination">https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/the-utility-of-and-indications-for-routine-pelvic-examination</a>
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Regular

Staying Healthy as an Immunocompromised Individual

2020 became the year when the word “immunocompromised” entered everyone’s vocabulary more than ever.&nbsp; As described by Penn Medicine, immunocompromised means that your “immune system’s defenses are low, affecting its ability to fight out illness and infection.”&nbsp; Because of the COVID-19 pandemic, many people became educated of different reasons one could be considered as having a weakened immune system: These including many other factors can increase your susceptibility to illness and infection, including the coronavirus.&nbsp; Our immune system is an intricate network comprised of cells and proteins that work together to stave off infections and protect the body. Many of us remember learning about white blood cells in school and how they work together to fight and defend the body against invading germs, infections and disease.&nbsp; Immunocompromised individuals are not only more prone to sickness and infections but an infected person with a weakened immunity may also experience prolonged or more serious symptoms, especially when compared to an infected individual with a healthy immune system.&nbsp; Even if an individual doesn’t have any of the aforementioned illnesses or conditions, it is possible still to have a weak immune system. One of the tell-tale signs is a predisposition to illness and infection.&nbsp; This could look like: A weak immune system can even lead to a variety of health issues, like autoimmune or blood disorders, digestive issues, and developmental delays in children.&nbsp; Alongside frequently getting sick, or frequently developing infections, another sign of a lowered immunity is when wounds will not heal as quickly as usual. Quick healing burns or cuts are dependent on a healthy immune system.&nbsp; The digestive tract plays a large role in a healthy immune system. A study published in January 2012, in a medical journal entitled Gut Microbes, researchers Hsin-Jung Wu and Erin Wu state that “keeping a delicate balance in the immune system by eliminating invading pathogens, while still maintaining self-tolerance to avoid autoimmunity, is critical for the body’s health.” Therefore another sign that someone may be suffering from lowered immunity can be if they exhibit many digestive issues.&nbsp; These can manifest as chronic diarrhea, constipation or gassiness. Without the correct amount of gut bacteria, one may become vulnerable to viruses, chronic inflammation of the intestinal tract, or in extreme cases, autoimmune disorders.&nbsp; Mental health can also affect one’s immunity. This is because stress lowers the number of lymphocytes in the body. Lymphocytes are the white blood cells that battle infection from within. The American Psychological Association, or the APA, has compiled a series of studies that reflect ways in which periods of high stress can weaken the immune system. Findings from numerous studies have shown periods of depression, loneliness or stress can all lower your immunity. They found long term or chronic stress has a significant ability to negatively affect one’s immunity. The negative effects of stress and depression on an individual’s immune system becomes even more severe when paired with old age. Stress can also lead to a lower energy level or trouble sleeping.&nbsp; Sometimes having trouble sleeping can be another symptom of a weakened immune system. When an individual’s immunity is low, their body attempts to conserve energy in order to properly fight off any viral attackers. This then can leave an immunocompromised individual feeling tired, even if they have had a full night’s sleep.&nbsp; Luckily, there are ways to assist a lowered immunity. During the COVID-19 pandemic, people worldwide learned one of the most important steps. It is also one of the most simple, and that is practicing good hygiene.&nbsp; Washing one’s hands as frequently as possible, and mostly at key moments such as before eating, or after touching garbage, is said to majorly decrease the spread of illness.&nbsp; Disinfecting objects around the home, especially those that are touched more often than others can also reduce the spread of illness by eliminating germs.&nbsp; Another easy method to avoid getting sick is to avoid being around people who are sick. During the coronavirus pandemic, many individuals practiced self-isolation. This is especially recommended for people with a weak immune system, at least until the conditions of the COVID-19 pandemic lessen.&nbsp; Now as COVID-19 vaccines are becoming available, medical experts believe we may be seeing the light at the end of the tunnel, as far as the fear surrounding the coronavirus goes. Doctors highly recommend that everyone stay up to date with all of their vaccinations. This includes the COVID-19 vaccine when it becomes more widely available.&nbsp; It is also recommended if an individual has a very weak immune system that they should be in close contact with their doctor regarding any vaccines, medical advice, or treatment.&nbsp; Although it has been a stressful time for many, stress does far more harm than good when the immune system is involved. Attempting to manage one’s stress is not only advisable for mental health, but also physical health.&nbsp; Here are some ways to do so: Stay aware of what you put into your body, and treat your body well and often your body will treat you well in return. Although there are conditions where regardless of how well an individual takes care of themselves, the immune system will still stay weakened.&nbsp; This is why, more than ever before, it is important to practice good hygiene, eat well, and attempt to stay away from stress.&nbsp; Until COVID-19 is a thing of the past, it is also of course essential to continue practicing social distancing.&nbsp; Remember if you or a loved one seems to have any of the symptoms listed above, to speak to a doctor and get a professional perspective. Especially as these symptoms can not only be a sign of a lowered immunity, but perhaps other medical issues.&nbsp; Stay safe, healthy, happy, and don’t forget to take time to yourself when you need it.&nbsp;

Our Care Providers

Paige Hasty
Paige Hasty
Medical Assistant
No Overview Provided

Gabriel Velez
Gabriel Velez
Nurse Practitioner
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Lubuw Falanruw
Lubuw Falanruw
Partner & Chief of Pacific Centric Health Tech “Technology is best when it brings people together.”

Michael Ajimura
Michael Ajimura
Medical Assistant
“ The purpose of our lives is to be happy.”

Michael Quay
Michael Quay
Mental Health Counselor
My name is Michael Quay. I graduated from Georgia State University with a M.S. in Rehabilitation Counseling in 1991. Initially, I worked with private sector workers’ compensation cases (primarily back injuries) then I was able to progress to serving as the Crisis Intervention Coordinator for a Public Mental Health Center. Here I coordinated the center’s emergency services which included consults to local jails & hospitals to evaluate primarily depression and suicide. In addition, I carried a caseload of 35-40 adults with a variety of mental health diagnoses. Over the years I developed an ability to work with borderline personality disorders due to their high frequency of using the center’s emergency line. After five years I moved on to serve as the clinical coordinator for a hospital based geriatric psychiatric day treatment program. Most of the clients were 65-90 and suffered depression and anxiety. The next two years I had the privilege of serving as the Children’s Pastor (Birth to 5th Grade) for a church with a Sunday attendance of about 1500. Over the next year I was ministering in Angeles City, Philippines as a missionary working with local church children’s workers. Finally, from 2003-2012 I had the honor to work as a School Based Behavioral Specialist (SBBH now SBS) working for the Hawaii Department of Education at three High/Intermediate Schools in East Hawaii. Most of my clients were Special Education, Oppositional-Defiant with A.D.D. My caseload was almost exclusively male & these were my favorite clients of all. I was a Certified Rehabilitation Counselor (C.R.C.) from 1991 to 2001. Also I was a Nationally Certified Counselor (N.C.C.) from 1996 to 2004. Those same years (1996-2004); I was a Licensed Professional Counselor (L.P.C.) in the State of Alabama. Recently, I became a Licensed Mental Health Counselor (L.M.H.C.) in the State of Hawaii. Among my interests professionally are depression, anxiety, A.D.D./Defiant Teens (especially males), families who have end of life issues with parents, marital counseling, & life care planning (not estate planning BUT working out your life plan). I am more of a person-centered therapist who believes YOU are the expert on your life. I do cognitive-behavioral mostly with teens & children. In addition to my years as a mental health professional, I am a U.S. Army Captain, Retired; who had the honor to go to Airborne School.

Paige Turner
Paige Turner
UH
"A Building With Four Walls And Tomorrow Inside"

Pamela Finch
Pamela Finch
Medical Assistant
"Make life beautiful" -- Shea McGee

Mark Causin
Mark Causin
Physician
If the path be beautiful, let us not ask where it leads

Chris Apostolides
Chris Apostolides
Physician Assistant
Your body is your most priceless possession...so go take care of it! Physician Assistant practicing Emergency Medicine for over 15 years. Masters of Science from Towson University, 2005. Certified by National Commission on Certification of Physician assistants since 2005.

Christina Robbins
Christina Robbins
Physician Assistant
Butterflies can't see their wings.

Isaiah Mallari
Isaiah Mallari
Nurse Practitioner
As a board certified Family Nurse Practitioner, Isaiah is both diligent in his practice and his passion of giving back to others. Isaiah received his Master of Science in Nursing from Hawaii Pacific University. Prior to joining NIU health as a provider, he worked in a number of critical care settings for the past 7 years and became a Certified Critical Care Registered Nurse. Having witnessed his father pass away at such a young age in the intensive care unit, it drove him to serving to this capacity. In his free time, he enjoys surfing, CrossFit, yoga, and trying out new restaurants.

Paul Coelho
Paul Coelho
Chief Nurse Executive
Dr. Paul Coelho was born and raised on the Island of Oahu. He received his Masters of Science in Nursing from the University of Hawaii at Manoa, and later obtained his Doctors of Nursing Practice from Hawaii Pacific University. He is board-certified as a Clinical Nurse Specialist by the American Nurses Credentialing Center. Paul is licensed as an Advanced Practice Registered Nurse with prescriptive authority in Hawaii. His medical specialties of interest and expertise include cardiology, HIV/AIDS care management & prevention, urgent care, and nurse management & leadership. Paul believes that NIU Health will provide him a platform to continue his passion for nursing practice and his dedication to improving the health and well being of the people of Hawaii. Paul considers a work-play balance important to maintain optimal physical and mental health, therefore, he enjoys hiking, running, surfing, playing tennis, and yoga.

Danine Dela Cruz
Danine Dela Cruz
Medical Assistant
Beauty begins the moment you decide to be yourself

Maricel Mercado
Maricel Mercado
Medical Assistant
Be your own kind of beautiful

Dr Tony Trpkovski
Dr Tony Trpkovski
CEO and Founder of NIU Health
Co-founder / CEO Doctors of Waikiki Board Certified Internal Medicine Best of USA-Best Physician 2016 Best of Kauai –Best Physician 2010-2011 Wright State University June 1994 to June 1997 Internship and Chief resident in Internal Medicine Miami Valley Hospital, Dayton Ohio “Sts Cyril and Methodius” Medical School Hospital Feb 1993 to Feb 1994 Internship General Medicine, Skopje, North Macedonia University of Sts Cyril and Methodius, School of Medicine Graduated Jan 1993 Skopje, North Macedonia Republic of North Macedonia: full scholarship faculty of medicine 1984-1993 “Always laugh when you can, it is cheap medicine.”

Alexis Barroga
Alexis Barroga
Nurse Practitioner
Alexis has always had a passion to help people and that’s why she pursued a career in Nursing. After earning her Bachelor of Science in Nursing at the University of South Alabama, she worked in a Surgical Trauma Intensive Care Unit in a Level 1 Trauma Center. It was a great learning experience but she was eager to learn more about patient care outside of the hospital setting. She became a Certified Family Nurse Practitioner because she wanted the opportunity to build rapport and play an active role in the overall health of her patients, ensuring they receive the right treatment and care to live long healthy lives. Alexis is beyond excited to join NIU Health and provide quality and cost-effective health care to her Hawaii Ohana. Her in-laws (grandma, parents, sisters, aunties, uncles, nephews, nieces, cousins) all live on island so she understands firsthand how difficult and expensive health care is. She believe’s this is something that has been missing from the healthcare system and she feel’s so blessed to be able to be a part of it.

Kasey Kam
Kasey Kam
Nurse Practitioner
Kasey is an Adult-Gerontology Primary Care Nurse Practitioner who first found his passion for healthcare while caregiving for his late father and grandparents. He went on to work at Straub Medical Center and a national nursing agency where he enjoyed working with the young and elderly alike. He is excited to be part of the NIU Health team because of the unique ways he’ll get to engage patients. He received his Doctor of Nursing Practice from the University of Hawaii at Manoa. In his downtime, he enjoys cooking Japanese, Italian, and local-style foods. Tomato gardening is his new favorite hobby.

Jamie Noguchi
Jamie Noguchi
Nurse Practitioner
Jamie has called O'ahu her home since the beginning, born and raised here on the island. She attended University of Hawai'i at Manoa for both her undergraduate and graduate degrees, completing UH Manoa's accelerated nursing program to become an Adult-Geriatric Nurse Practitioner. Due to being very close with her grandparents and witnessing their later years of life, her career experience has been focused largely in neurology and primary care, with a special interest in the ever-developing field of dementia and cognitive impairment. She especially enjoys building lifelong relationships with her patients, and seeing families grow over the years with thriving health. She is very excited to join NIU HEALTH because of its fresh take on providing quality, consistent healthcare to everyone. Its philosophy looks toward the future, is fair and affordable, and presents a solution that works for all types of socioeconomic situations. And now more than ever, that is exactly what the world needs.

Amanda Buzynski
Amanda Buzynski
Nurse Practitioner
Amanda Y. Buzynski, FNP-BC, APRN-RX, SAFE is a Queens, NY Native. She is a Family Nurse Practitioner and a Forensic Examiner. In 2019, Amanda received her Master of Science as a Family Nurse Practitioner from D’Youville College in Buffalo, NY. She has gained seven years of experience at the Erie County Medical Center emergency department; a level 1 Trauma Center. Currently, she works on the island of Oahu, in the emergency department at Queens Medical Center. Amanda has spent the last few years as a “Stop the Bleed” instructor and has taught the life-saving educational program at schools, community events, and even brought the training to rural Sierra Leone during a medical mission trip. Her hobbies include travelling, learning about new cultures, and learning how to cook the cuisine from the countries she visits. She has a special interest in nutrition as an adjunct therapy for many chronic diseases. Amanda believes that access to healthcare is a human right, and that NIU health is a revolutionary way to expand access to healthcare to the people of Hawaii. She is very excited to be a part of the next phase of healthcare with NIU Health.